Psycho-Babble Medication Thread 1111341

Shown: posts 1 to 13 of 13. This is the beginning of the thread.

 

OCD Exacerbation

Posted by Bones on July 23, 2020, at 8:14:42

Hello everyone.
I am experiencing a relapse and what seems like an extreme exacerbation of my OCD symptoms. It's been 20 years since my last relapse. I'm feeling overwhelmed and hopeless at times that I will ever improve. This has been going on for about a month. I know these are difficult times for everyone with the COVID epidemic and restrictions as a result. Saying that, I didn't think that I was feeling too anxious about COVID and don't think this was the cause of my relapse. Perhaps I am just unconscious of feelings. I am a nurse (mental health) (retiring soon and now on sick leave). I'm finding it challenging not being able to see my psychologist face to face. Somehow the online interview does not have the same impact as when you are sitting and being with a person. I will be starting with a couple of peer support groups, but again they will be online. I started increasing my Zoloft but at 100 mg. didn't find it was giving much release from anxiety and obsessional thoughts. I was also taking scheduled benzos during the day. We changed to Pristiq as my daughter is on it for depression and it is working well for her major depressive disorder. (She paid for the genetic testing for antidepressant use and prescribed as a result.) I was experiencing side effects from the Pristiq so am now taking Paxil which I was on for almost 10 years during the 90's. I'm trying to stay away from benzos on recommendation of psychologist who specializes in OCD and taking Pregablin 125 mg every 8 hrs. I'm experimenting with sleep medications as mentioned as trying to avoid benzos and currently taking Trazadone and Zopiclone together. Sometimes just Trazadone. A fear of not being able to sleep has always been an aspect of my OCD. For last few weeks I was taking Temazepam 30 mg at night to sleep.I wake every morning very anxious. Even when taking Temazepam. My doc thinks this may be withdrawal from the benzos. I've had a lot of drug changes in the past month.
I guess I'm writing for encouragement and also to ask if anyone else with OCD has felt this way before. A relapse where you are bombarded with old and new obsessions. Did you think you would never return to stability? Another question. Do you think it is worthwhile to do genetic drug testing to see which antidepressant would work the best for me?

Thank you everyone and to this forum which provides wonderful support to those who are suffering from mental illness.

 

Re: OCD Exacerbation

Posted by Christ_empowered on July 23, 2020, at 14:18:55

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

So sorry. Maybe vyvanse?

 

Re: OCD Exacerbation

Posted by Hugh on July 24, 2020, at 0:52:25

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

It's possible that benzo withdrawal could be exacerbating your OCD. I took Ativan for insomnia. I started to develop inter-dose withdrawal symptoms, so I did a four-month taper to get off of it, doing a crossover to Valium halfway through my taper.

Benzo withdrawal made my depression and anxiety and insomnia far worse than they had ever been. The Ashton Manual was very helpful during my taper.

https://www.benzo.org.uk/manual/contents.htm

 

Re: OCD Exacerbation

Posted by undopaminergic on July 25, 2020, at 5:27:41

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

I have no personal experience with OCD, but I know that there can be difficult times where it feels like it will never get better; that is the depression (or OCD) speaking. The reality of it is that you will have to see how it turns out -- you can't predict the future based on how you feel in the moment (or even month or year).

-undopaminergic

 

Re: OCD Exacerbation Bones

Posted by SLS on July 25, 2020, at 10:04:09

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

Hi, Bones.

Using a benzodiazepine for sleep might be counterproductive. These drugs affect negatively sleep architecture, and might leave you feeling less rested the following day. And, yes, daily "withdrawal" from using a BZD with a short half-life might be worse than a longer-acting BZD. There is also the issue of rebound awakening. As far as BZDs to sleep, I think temazepam is a good choice, but I think the newer "Z" drugs that target only one BZD subreceptor that does not act as an anxiolytic might make more sense.

Zolpidem (Ambien) might be a better choice. It puts me to sleep right away. I usually wake up once during the night with zolpidem. Maybe it's a type of rebound awakening, but I'm not sure. Zolpidem does have a rather short half-life, but it is a clean drug - 10 mg at bedtime. The thing is, you need to get into bed *immediately* after taking zolpidem. There is a short "window" of time beyond which it is less effective - or not effective at all.

There are longer-acting Z-drugs, but I have no experience with them.

Peaple have recommended quetiapine (Seroquel) at very low dosages for sleep. It is not very potent as a D2 receptor antagonist at low dosages, so it might be the antipsychotic with the lowest incidence of extrapyramidal symptoms (EPS).

For me, trazodone and mirtazapine are too "yucky".


- Scott

 

Re: OCD Exacerbation

Posted by Hugh on July 26, 2020, at 0:39:37

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

The beta-blocker pindolol (2.5 mgx3/d) was used in this study for treatment-resistant OCD.

https://pubmed.ncbi.nlm.nih.gov/10793318/

This study for treatment-resistant depression found that 7.5 mg of pindolol once daily was more effective than 2.5 mg three times a day.

https://pubmed.ncbi.nlm.nih.gov/15006431/

NAC can help OCD. It's best to take it on an empty stomach.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488488/

Deep TMS might be worth trying, if your insurance covers it.

 

Re: OCD Exacerbation

Posted by pixel8mbb on July 26, 2020, at 1:09:42

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

I'm so sorry for your struggle/suffering. Not sure if what I can tell you will be relevant for you but hope it's worth a read.

My mother told me my OCD began when I was age 5. In addition to that I have ADD, generalized anxiety and depression. Having ADD and OCD together are I believe like having an internal conflict going on a lot of the time. Starting in my 20s I had psychiatric therapy for many years with no attention paid to diagnosing my OCD or ADD, just talk that helped in a small and limited way. After that I diagnosed myself, left therapy and tried tons of meds with a meds doc for quite a few years, and none of those helped much. I haven't been taking anything for quite a while, just a little melatonin for sleep at the moment.

But now, I'm finally having something that's helping, deep TMS treatments, approved by the FDA for OCD. I'm guessing you know about that, maybe even tried it. I know not everyone has success, but this is my second try, and I think I was extremely lucky in having a second chance at finding a skilled psychiatrist who administers it correctly, by presenting me with psychological provocations tailored to my OCD triggers beforehand, and using the H-7 coil of the Brainsway deep TMS machine. He first used the H-1 coil for my depression, but switched to the H-7 coil, which Brainsway recommends for both depression and OCD. I'm about halfway through the series, and feel very encouraged.

For me, the way TMS is provided made a big difference. My first provider delegated treatments to less skilled technicians, with nothing done to introduce provocations. Even so, I felt some improvement, even like I was becoming quite a different person. But in the middle of treatment that provider made a mistake in reporting my results to Medicare (I'm at retirement age), making it look like I was cured, and Medicare stopped my treatments.

But leaving that provider led to my finding a better one. After a lapse of a few months I started treatments with him, and I'm now about halfway through the series and even more encouraged than before.

In addition to the provocation protocols, providers need to be knowledgeable about getting equipment settings just right, finding the correct placement of the helmet that aims pulses into the part of the brain where OCD comes from, also the right amount of energy required for your particular response, calibrated before the first session and then carefully kept consistent, and re-checked frequently.

I hope this might be of some help, but in any case, I sincerely hope you find some relief.

 

Re: OCD Exacerbation

Posted by pixel8mbb on July 26, 2020, at 1:15:22

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

PS - Sorry forgot to mention, wearing masks should of course be done by doctor and patient during TMS, and although a practitioner needs to be close to the machine where the patient sits, they stand behind it, and can be careful to social distance as much as possible.

 

Re: OCD Exacerbation pixel8mbb

Posted by Hugh on August 1, 2020, at 18:52:12

In reply to Re: OCD Exacerbation, posted by pixel8mbb on July 26, 2020, at 1:09:42

I'd never heard of provocation protocols for Deep TMS. You're fortunate that, the second time around, you found an innovative provider, instead of one who uses a one-size-fits-all approach.

 

Re: OCD Exacerbation

Posted by pixel8mbb on August 1, 2020, at 21:57:39

In reply to Re: OCD Exacerbation pixel8mbb, posted by Hugh on August 1, 2020, at 18:52:12

Yes, I was fortunate indeed. But my provider is not innovative exactly, he is following the protocols which Brainsway, the manufacturer who makes the H7 coils, specifies for OCD treatment. I believe they were used for their clinical trials too. In case anyone in the Bay Area is interested in this clinic, I'd highly recommend Pacific Psychiatric Associates, in downtown Oakland. Dr Travis has an impressive bio on their website. His manner is kind and humble, which I found surprising and comforting after dealing with other psychiatrists who were less skilled, and often arrogant.

> I'd never heard of provocation protocols for Deep TMS. You're fortunate that, the second time around, you found an innovative provider, instead of one who uses a one-size-fits-all approach.

 

Re: OCD Exacerbation Bones

Posted by SLS on August 11, 2020, at 15:43:26

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

In general, it takes significantly longer for an antidepressant to begin working for OCD than for depression. Also, the effective dosages tend to be higher. I don't know about other types of drug treatments.

Besides COVID-19, have you had any other stressors that might have impacted your nervous system?

I hope you find relief soon.


- Scott

 

Re: OCD Exacerbation

Posted by phidippus on October 6, 2020, at 4:42:10

In reply to OCD Exacerbation, posted by Bones on July 23, 2020, at 8:14:42

I am in recovery from OCD. I've experienced harming thoughts and hypochondria. I have been on many medications and often felt like there was no end in sight, no relief. But I was patient and found the right combination of medications. I currently take Vraylar, Lyrica and Trintellix for my OCD and bipolar disorder. I have found that you need to attack OCD with different medications at once. Have you tried an antipsychotic?

 

Re: OCD Exacerbation

Posted by Lamdage22 on October 14, 2020, at 6:10:44

In reply to Re: OCD Exacerbation, posted by phidippus on October 6, 2020, at 4:42:10

Can actually make it worse.
https://pubmed.ncbi.nlm.nih.gov/25256097/

> Have you tried an antipsychotic?


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